Younger women still getting mammograms despite Uncle Sam s advice

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Despite a 2009 advisory from a federal advisory panel that women under age 50 avoid routine screening mammography unless discussed with her medical caregiver, a new study by researchers at Johns Hopkins School of Medicine found that younger women continued to get screening mammograms at the same rate in 2010 as before the panel report. The data were accumulated by a federal survey, and the mammography rates for the years 2006, 2008 and 2010 were reported.

In 2009, the United States Preventive Services Task Force (USPSTF) issued its advisory, after reviewing copious data and evidence-based studies on the relative risks and benefits of routine annual mammogram screening for women in the under-50 vs. age 50-74 age groups. The panel, whose members are selected for their overall expertise and for their lack of ties to any special interest group or advocacy agenda, stated that the evidence for a net health benefit for women under-50 from routine mammograms was lacking. In fact, they said that the harms likely to flow from abnormalities detected in younger woman requiring follow-up tests and treatments (including surgeries and radiation) for lesions that were not life-threatening far outweighed the benefits of saving lives from breast cancer via earlier detection in that age group.

In another controversial declaration, they asserted that older women (50-74) could get by with every-other-year rather than annual exams. The report generated a firestorm of criticism, with some stating that the panel was compromised by an expense-saving agenda, although the prime directive (to borrow a Star Trek term) of the panel is to pay no attention whatsoever to cost controls in their epidemiological and statistical analyses.

Among younger women, the rates of mammography screening remained in the 52-53 percent range from 2006 through 2010 (in older women, the rates also remained pretty stable, around 64 percent, raising the question as to why more older women are not getting mammograms as often as recommended). The reasons for this lack of adherence to the panel recommendation are manifold: one obvious explanation is simple inertia: women and their doctors have been doing things a certain way for over three decades now, and a u-turn on such an emotional issue was never likely. Certainly, one year s worth of data is far too short a period to make a valid evaluation. Also, the fact that annual mammograms are still almost universally covered by insurers, and the rather stubborn refusal to agree with the USPSTF by the American Cancer Society and some other professional organizations, are sure to sow confusion and doubt among both women and doctors.

ACSH s Dr. Gilbert Ross had this to add: We must emphasize that these advisories are solely directed towards routine annual mammographic screening. If a woman has cause to believe she has, or if her doctor diagnoses her, to be at increased risk of breast cancer, all bets are off. In those cases, more frequent mammograms and other studies, such as sonograms and MRIs, may be in order. But changing common practice in this area is not going to happen in a short period of time, whatever its statistical benefits.